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The interpreter's role in medical consultations as perceived and as interactionally negotiated: a study of a Flemish hospital setting, using interview data and video recorded interactions

(2013)
Author
Promoter
(UGent) and Hildegard Vermeiren
Organization
Abstract
Context: In the WHO European Region there are approximately 75 million migrants (WHO, 2010). Demographic changes as a result of immigration inflows usually entail both linguistic and cultural diversity within the host societies. The linguistic diversity often results in language barriers in the communication between the immigrant and host population. One of the public sectors in which language barriers occur and have an impact upon is the sector of healthcare services. In response to the increasing immigrant patient population and its linguistic diversity, Belgian hospitals, in a similar way to hospitals in other EU-member states, provide professional interpreting and cultural mediation services in order to ensure equal access to healthcare for immigrant patients with limited language proficiency in the official language of the host community. Need : Previous research on community interpreting in the fields of Interpreting Studies and Medicine has provided invaluable research on the interpreter’s function. However, the interpreter’s “role”, as is mostly cited in the literature, does not seem to be clear-cut. In other words, the term “role”, when referring to community interpreters, is used to denote either interpreters’ actions, or their own and/or others’ expectations of them. In addition, the same term is also used as a synonym for the interpreters’ tasks. More specifically, a review of the relevant literature from the fields of Interpreting Studies and Medicine with an interest in interpreter-mediated communication reveals: i) a discontinuity between, research/theory and interpreting practice; ii) a problematic use of the term “role” to refer to the interpreter’s function, as well as iii) an information gap between the medical and interpreting literature on the interpreter’s “roles”. The above tendencies result in a fragmented approach to the study of the interpreter’s function. Object: The object of this study is to investigate the professional interpreter’s function in mediated medical consultations and shed light on the organization of mediated discourse. In order to orient adequately to the above topic, I explored the following questions: i) what is understood by the interpreter’s function; ii) how is the interpreter’s function perceived by practitioners and users of interpreting services, and iii) how is the interpreter’s function negotiated in interaction, by taking participants’ both verbal and non-verbal communication (i.e. gaze and body orientation) into account. Method: In order to address the above questions I studied interpreter-mediated interactions in healthcare settings and participants’ views on the interpreter’s function, and interpreter-mediated communication. The selected data, upon which this study reports, consist of: i) 9 video-recorded mediated consultations with Dutch speaking doctors, Russian-, Turkish-, and Arabic-speaking patients; ii) 25 audio recorded semi-structured interviews with Dutch-speaking doctors and professional interpreters. The data were collected at a large urban hospital in Flanders. The study has been approved by the hospital ethics committee and participants’ oral and written informed consent was obtained prior to their inclusion in the study. The recorded data (consultations and interviews) were transcribed and translated into Dutch. Two distinct, yet complementary, methods of analysis were applied. The method of qualitative content analysis that was applied during the analysis of the transcribed interviews enabled me to investigate participants’ (self)perceptions of the interpreter’s function in mediated medical interaction. This analytical method addresses the way in which the interpreter’s function is perceived both by doctors and interpreters. For the analysis of the transcribed consultations I employed two methods of analysis, namely qualitative content analysis and, at a later stage, aspects of Goffman’s (1981) participation framework. The first level of analysis, which is, to a large extent, based on qualitative content analysis and provides a stepping stone for the next level, allowed me to i) identify participants’ actions within interaction, ii) acquire an initial overview of the underlying meaning through the study of participants’ actions, and iii) identify an initial layer of role assumption by/attribution to participants in the course of interaction. In order to study the dynamics that are inherent in interaction, Goffman’s (1981) participation framework was applied in order to increase our understanding of i) the negotiation of meaning among participants, as well as ii) of the way in which participants relate to each other and co-construct meaning in the course of interaction. The study of participation frameworks enabled the study of the interpreter’s function as negotiated in the interaction in a setting that is characterized by asymmetrical relationships. Findings: In my analysis of the interpreters’ perceptions it was demonstrated that the professional interpreters who participated in this study perceived their function in terms of a linguistic conduit. It emerged that the above perception is primarily shaped by the interpreters’ normative framework (code of conduct/ethics). However, it was shown that the interpreters in this study are likely to perform actions beyond, and in addition to, the act of interpreting (e.g. filtering out irrelevant information, steering primary participants toward relevant information, etc.) without always being aware of the incompatibility of their actions with the normative framework they claim to abide by. The interpreters who were likely to perform actions in addition to interpreting perceived their function as facilitating communication. On the contrary, the interpreters who would only provide interpretation, perceived their function as enabling communication. The analysis of the participants’ perceptions revealed that doctors in general seem to be insufficiently aware of or acquainted with the interpreter’s function. Evidence of the impact of the doctors’ lack of knowledge about the interpreter’s function and role performance vis-à-vis the interpreter’s normative role is provided. The doctors in this study appear to share the interpreters’ self-perception as linguistic conduits. Their lack of knowledge about the interpreter’s function results in a striking divergence between their perceptions and expectations of the interpreters’ function. More specifically, while the doctors in this study perceive interpreters as linguistic conveyors, their expectations of them illustrate a more expanded function that exceeds the competence of a linguistic conduit. The divergence between the doctors’ perceptions and expectations of interpreters is indicative of the former’s lack of information on the interpreter’s function. However, despite the lack of knowledge, the doctors in this study appear to trust professional interpreters. Their trust stems primarily from the interpreters’ professional status, as opposed to ad hoc interpreters. Yet, the negative impact of professional interpreting on the consultation process and on the communication with the patient was also flagged up by the doctors in this study. The analysis of interpreter-mediated consultations revealed that the interpreters in this study assumed roles (in Goffman’s terms) that are removed from the model of the linguistic conduit and that they performed actions beyond the act of interpreting. The analysis of the mediated interactions revealed an interdependency between interpreters’ actions that have an immediate effect on the text and actions that coordinate the interaction. It was shown that the interpreters employed strategies by means of body orientation and gaze that project a detached self (i.e. body oriented toward the (speaking) primary participant(s), yet without directing gaze at them). In doing so, interpreters seem to display availability for participation, while at the same time projecting the image of a disengaged participant. While one would expect that the interpreters’ non-verbal actions that gravitate toward the image of the interpreter as a detached linguistic conduit would be supported by the interpreters’ assumption of the role of animator (Goffman, 1981), my analysis of the interaction revealed a different pattern. The role of animator was replaced by the role of author and, at times, by the role of author/principal (Goffman, 1981). This entails a higher degree of visibility and involvement on the interpreters’ part that exceeds the perception of the interpreter as a linguistic conduit. Conclusion: Approaching the interpreter’s function from two different angles, namely through the study of perceptions of it and through the study of its negotiation within interaction, has offered new insights into the study of the interpreter’s function. To put it differently, the study of the interpreter’s function may benefit significantly from the parallel study of the interpreter’s actions against the interpreter’s and the primary participants’ expectations and the interpreter’s task as stipulated in the interpreter’s code of conduct/ethics. In other words, I suggest that the study of the interpreter’s function should provide a response to the following questions, which, in my view, when investigated in parallel fashion, are more likely to offer a less fragmented and, therefore, a more realistic view of the interpreter’s function: i) What actions should the interpreter perform according to his/her code of conduct? (Task) ii) What actions is the interpreter expected by others to perform? (Expectations) iii) What actions is the interpreter performing during the study of interaction? (Actions) I argue that the above approach (what I refer to as the T.E.A. framework) can allow us to gain an understanding of the interpreter’s function in a way that is closer to the negotiated and co-constructed reality of mediated interaction, as opposed to more conventional descriptions of interpreters’ “roles” as found in the literature, which seem to overlook the interplay between the dynamic aspects of the interpreter’s function in interaction and focus instead on fragmented views of it. In sum, this study suggests an alternative take on the study of the interpreter’s function by proposing a three-dimensional approach to it, namely the T.E.A. framework, which enhances our understanding of the interpreter’s role enactment while taking the interpreter’s, as well as the primary participants’ perceptions, as well as their verbal- and non-verbal behaviour into account, and by providing evidence of the interpreter’s (dis)engagement/(un)availability for participation during role enactment. In this way, the framework offers further insights into the way in which professional interpreters perform coordinating actions (e.g. only by means of non-verbal communication) and thus enriches our understanding of the other participants’ role attributions to interpreters, which a transcript of only verbal interaction would have failed to do (e.g. by means of what I called split ratification). Therefore, this study opens up new trajectories for the use of Goffman’s (1981) participation framework by revealing aspects of it that are likely to emerge in interpreter-mediated interaction. Finally, the proposed framework provides assumptions and first indicators about the professional interpreters’ impact on the concept of patient-centredness and invites further research on a topic with high relevance both for the field of Interpreting Studies, as well as for the field of Medicine.
Keywords
Goffman, healthcare, interpreter, role

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Citation

Please use this url to cite or link to this publication:

MLA
Krystallidou, Demi. “The Interpreter’s Role in Medical Consultations as Perceived and as Interactionally Negotiated: a Study of a Flemish Hospital Setting, Using Interview Data and Video Recorded Interactions.” 2013 : n. pag. Print.
APA
Krystallidou, D. (2013). The interpreter’s role in medical consultations as perceived and as interactionally negotiated: a study of a Flemish hospital setting, using interview data and video recorded interactions. Ghent University. Faculty of Arts and Philosophy, Ghent, Belgium.
Chicago author-date
Krystallidou, Demi. 2013. “The Interpreter’s Role in Medical Consultations as Perceived and as Interactionally Negotiated: a Study of a Flemish Hospital Setting, Using Interview Data and Video Recorded Interactions”. Ghent, Belgium: Ghent University. Faculty of Arts and Philosophy.
Chicago author-date (all authors)
Krystallidou, Demi. 2013. “The Interpreter’s Role in Medical Consultations as Perceived and as Interactionally Negotiated: a Study of a Flemish Hospital Setting, Using Interview Data and Video Recorded Interactions”. Ghent, Belgium: Ghent University. Faculty of Arts and Philosophy.
Vancouver
1.
Krystallidou D. The interpreter’s role in medical consultations as perceived and as interactionally negotiated: a study of a Flemish hospital setting, using interview data and video recorded interactions. [Ghent, Belgium]: Ghent University. Faculty of Arts and Philosophy; 2013.
IEEE
[1]
D. Krystallidou, “The interpreter’s role in medical consultations as perceived and as interactionally negotiated: a study of a Flemish hospital setting, using interview data and video recorded interactions,” Ghent University. Faculty of Arts and Philosophy, Ghent, Belgium, 2013.
@phdthesis{4086069,
  abstract     = {{Context: In the WHO European Region there are approximately 75 million migrants (WHO, 2010). Demographic changes as a result of immigration inflows usually entail both linguistic and cultural diversity within the host societies. The linguistic diversity often results in language barriers in the communication between the immigrant and host population. One of the  public sectors in which language barriers occur and have an impact upon is the sector of healthcare services. In response to the increasing immigrant patient population and its linguistic diversity, Belgian hospitals, in a similar way to hospitals in other EU-member states, provide professional interpreting and cultural mediation services in order to ensure equal access to healthcare for immigrant patients with limited language proficiency in the official language of the host community.
Need : Previous research on community interpreting in the fields of Interpreting Studies and Medicine has provided invaluable research on the interpreter’s function. However, the interpreter’s “role”, as is mostly cited in the literature, does not seem to be clear-cut. In other words, the term “role”, when referring to community interpreters, is used to denote either interpreters’ actions, or their own and/or others’ expectations of them. In addition, the same term is also used as a synonym for the interpreters’ tasks. More specifically, a review of the relevant literature from the fields of Interpreting Studies and Medicine with an interest in interpreter-mediated communication reveals: i) a discontinuity between, research/theory and interpreting practice; ii) a problematic use of the term “role” to refer to the interpreter’s function, as well as iii) an information gap between the medical and interpreting literature on the interpreter’s “roles”. The above tendencies result in a fragmented approach to the study of the interpreter’s function.
Object: The object of this study is to investigate the professional interpreter’s function in mediated medical consultations and shed light on the organization of mediated discourse. In order to orient adequately to the above topic, I explored the following questions: i) what is understood by the interpreter’s function; ii) how is the interpreter’s function perceived by practitioners and users of interpreting services, and iii) how is the interpreter’s function negotiated in interaction, by taking participants’ both verbal and non-verbal communication (i.e. gaze and body orientation) into account. 
Method: In order to address the above questions I studied interpreter-mediated interactions in healthcare settings and participants’ views on the interpreter’s function, and interpreter-mediated communication. The selected data, upon which this study reports, consist of: i) 9 video-recorded mediated consultations with Dutch speaking doctors, Russian-, Turkish-, and Arabic-speaking patients; ii) 25 audio recorded semi-structured interviews with Dutch-speaking doctors and professional interpreters. The data were collected at a large urban hospital in Flanders. The study has been approved by the hospital ethics committee and participants’ oral and written informed consent was obtained prior to their inclusion in the study.
The recorded data (consultations and interviews) were transcribed and translated into Dutch. Two distinct, yet complementary, methods of analysis were applied. The method of qualitative content analysis that was applied during the analysis of the transcribed interviews enabled me to investigate participants’ (self)perceptions of the interpreter’s function in mediated medical interaction. This analytical method addresses the way in which the interpreter’s function is perceived both by doctors and interpreters.
For the analysis of the transcribed consultations I employed two methods of analysis, namely qualitative content analysis and, at a later stage, aspects of Goffman’s (1981) participation framework. The first level of analysis, which is, to a large extent, based on qualitative content analysis and provides a stepping stone for the next level, allowed me to i) identify participants’ actions within interaction, ii) acquire an initial overview of the underlying meaning through the study of participants’ actions, and iii) identify an initial layer of role assumption by/attribution to participants in the course of interaction. In order to study the dynamics that are inherent in interaction, Goffman’s (1981) participation framework was applied in order to increase our understanding of i) the negotiation of meaning among participants, as well as ii) of the way in which participants relate to each other and co-construct meaning in the course of interaction. The study of participation frameworks enabled the study of the interpreter’s function as negotiated in the interaction in a setting that is characterized by asymmetrical relationships.
Findings: In my analysis of the interpreters’ perceptions it was demonstrated that the professional interpreters who participated in this study perceived their function in terms of a linguistic conduit. It emerged that the above perception is primarily shaped by the interpreters’ normative framework (code of conduct/ethics). However, it was shown that the interpreters in this study are likely to perform actions beyond, and in addition to, the act of interpreting (e.g. filtering out irrelevant information, steering primary participants toward relevant information, etc.) without always being aware of the incompatibility of their actions with the normative framework they claim to abide by. The interpreters who were likely to perform actions in addition to interpreting perceived their function as facilitating communication. On the contrary, the interpreters who would only provide interpretation, perceived their function as enabling communication.
The analysis of the participants’ perceptions revealed that doctors in general seem to be insufficiently aware of or acquainted with the interpreter’s function. Evidence of the impact of the doctors’ lack of knowledge about the interpreter’s function and role performance vis-à-vis the interpreter’s normative role is provided. The doctors in this study appear to share the interpreters’ self-perception as linguistic conduits. Their lack of knowledge about the interpreter’s function results in a striking divergence between their perceptions and expectations of the interpreters’ function. More specifically, while the doctors in this study perceive interpreters as linguistic conveyors, their expectations of them illustrate a more expanded function that exceeds the competence of a linguistic conduit. The divergence between the doctors’ perceptions and expectations of interpreters is indicative of the former’s lack of information on the interpreter’s function. However, despite the lack of knowledge, the doctors in this study appear to trust professional interpreters. Their trust stems primarily from the interpreters’ professional status, as opposed to ad hoc interpreters. Yet, the negative impact of professional interpreting on the consultation process and on the communication with the patient was also flagged up by the doctors  in this study.
The analysis of interpreter-mediated consultations revealed that the interpreters in this study assumed roles (in Goffman’s terms) that are removed from the model of the linguistic conduit and that they performed actions beyond the act of interpreting. The analysis of the mediated interactions revealed an interdependency between interpreters’ actions that have an immediate effect on the text and actions that coordinate the interaction. It was shown that the interpreters employed strategies by means of body orientation and gaze that project a detached self (i.e. body oriented toward the (speaking) primary participant(s), yet without directing gaze at them). In doing so, interpreters seem to display availability for participation, while at the same time projecting the image of a disengaged participant. While one would expect that the interpreters’ non-verbal actions that gravitate toward the image of the interpreter as a detached linguistic conduit would be supported by the interpreters’ assumption of the role of animator (Goffman, 1981), my analysis of the interaction revealed a different pattern. The role of animator was replaced by the role of author and, at times, by the role of author/principal (Goffman, 1981). This entails a higher degree of visibility and involvement on the interpreters’ part that exceeds the perception of the interpreter as a linguistic conduit.
Conclusion: Approaching the interpreter’s function from two different angles, namely through the study of perceptions of it and through the study of its negotiation within interaction, has offered new insights into the study of the interpreter’s function. To put it differently, the study of the interpreter’s function may benefit significantly from the parallel study of the interpreter’s actions against the interpreter’s and the primary participants’ expectations and the interpreter’s task as stipulated in the interpreter’s code of conduct/ethics. In other words, I suggest that the study of the interpreter’s function should provide a response to the following questions, which, in my view, when investigated in parallel fashion, are more likely to offer a less fragmented and, therefore, a more realistic view of the interpreter’s function: 
i) What actions should the interpreter perform according to his/her code of conduct? (Task)
ii) What actions is the interpreter expected by others to perform? (Expectations)
iii) What actions is the interpreter performing during the study of interaction? (Actions)
I argue that the above approach (what I refer to as the T.E.A. framework) can allow us to gain an understanding of the interpreter’s function in a way that is closer to the negotiated and co-constructed reality of mediated interaction, as opposed to more conventional descriptions of interpreters’ “roles” as found in the literature, which seem to overlook the interplay between the dynamic aspects of the interpreter’s function in interaction and focus instead on fragmented views of it. 
In sum, this study suggests an alternative take on the study of the interpreter’s function by proposing a three-dimensional approach to it, namely the T.E.A. framework, which enhances our understanding of the interpreter’s role enactment while taking the interpreter’s, as well as the primary participants’ perceptions, as well as their verbal- and non-verbal behaviour into account, and by providing evidence of the interpreter’s (dis)engagement/(un)availability for participation during role enactment. In this way, the framework offers further insights into the way in which professional interpreters perform coordinating actions (e.g. only by means of non-verbal communication) and thus enriches our understanding of the other participants’ role attributions to interpreters, which a transcript of only verbal interaction would have failed to do (e.g. by means of what I called split ratification). Therefore, this study opens up new trajectories for the use of Goffman’s (1981) participation framework by revealing aspects of it that are likely to emerge in interpreter-mediated interaction. Finally, the proposed framework provides assumptions and first indicators about the professional interpreters’ impact on the concept of patient-centredness and invites further research on a topic with high relevance both for the field of Interpreting Studies, as well as for the field of Medicine.}},
  author       = {{Krystallidou, Demi}},
  isbn         = {{9789090274805}},
  keywords     = {{Goffman,healthcare,interpreter,role}},
  language     = {{eng}},
  pages        = {{303}},
  publisher    = {{Ghent University. Faculty of Arts and Philosophy}},
  school       = {{Ghent University}},
  title        = {{The interpreter's role in medical consultations as perceived and as interactionally negotiated: a study of a Flemish hospital setting, using interview data and video recorded interactions}},
  year         = {{2013}},
}